|
Objective: To observe the restrictive transfusion of lobectomy in patients with perioperative provide a theoretical basis for the clinical line lobectomy patients perioperative fluid management. Methods: 94 cases of ASA Ⅰ - Ⅱ grade elective anesthesia combined with epidural anesthesia the downstream lobe resection patients were randomly divided into the conventional infusion group (A, n = 31), limit infusion group (B, n = 31 ), restrictions infusion group (C group, n = 32). Three groups under local anesthesia, internal jugular vein, radial artery, T4-6 epidural catheter bronchial intubation and mechanical ventilation, after induction of anesthesia, before the start of surgery, lung ventilation, after the start of surgery changed to one-lung ventilation, tidal volume Set 5-6ml/kg, respiratory rate 14-17 times / min, suction: call (I: E) = 1:1.5-2. Epidural intermittent given the Lieb mixture (2% lidocaine: 0.5% levobupivacaine hydrochloride = 1:1) to maintain analgesia. Intrathoracic operation after restoration lung ventilation to the end of surgery, three groups of postoperative indwelling epidural tube for postoperative analgesia. A group of conventional infusion, B, patients in group C, respectively enter 5ml/kg.h.10ml/kg.h liquid sodium lactate Ringer's solution (hereinafter referred to as: Stringer): hydroxyethyl starch 130/0.4 (hereinafter referred to as: 10 000 Timor) = 1:1] until the end of surgery. The three groups intraoperative blood loss with an equal amount Voluven supplement. (1) thoracotomy records patient general anesthesia time, single-lung ventilation, surgical time; (2), respectively, after the burglary (To), induced after the intubation (T1), thoracotomy of 5min (T2). 30min (T3). lobectomy (T4), off the chest immediately (T5), surgery completed (T6), six-time points record non-invasive blood pressure (BP), mean arterial pressure (MAP), central venous pressure (CVP) heart rate (HR), electrocardiogram (ECG), respiration (PR), pulse oximetry (SP02) tidal carbon dioxide partial pressure (PETCO2), airway pressure (Peak): (3) in the To and T4, T6 three time points drawing blood for blood gas analysis and red blood hematocrit (Hct), hemoglobin (Hb) detection; (4) in the venous blood 5m1 To and T4, T6, after 24h, 48h after five time points, with measured by ELISA in plasma IL-6, IL-8 levels; (5) recorded intraoperative urine output, blood loss, transfusion volume, the amount of drug use in surgery and type of 24h after infusion volume, urine, pleural drainage and postoperative chest drainage; (6) record postoperative awakening time, extubation time to chest drain removal time, exhaust defecation Time for the first time, preoperative and postoperative 3d breath-hold time, postoperative hospital stay ; (7) record postoperative hypertension, arrhythmia, wound healing bad, the occurrence of heart failure, high fever, nausea, vomiting, and hypotension. Results: 1, three sets of cytokines IL-6, IL-8 levels of T4 begins to rise, T6 reached a peak, after 24h decreased 48h after surgery did not recover to the preoperative level; within-group comparisons at each time point in group B , C group was not statistically significant, B, C group compared with group A result of significantly lower statistically significant (P lt; 0.05). 24h after chest drainage was no significant difference of the flow of group B and group C, a significant reduction in group A than those in the two groups (P lt; 0.05), B group cited traffic is only 1/2 of the group A total pleural drainage B group lt; the C groups lt; group A (P lt; 0.05); the 24h after fluid balance group B for mild negative balance, was significantly lower in group A and group C, P lt; 0.05; intraoperative blood loss B Group C was significantly less than that in group A (P lt; 0.05); intraoperative urine volume and postoperative 24h urine output, postoperative nausea and vomiting, wound infection, arrhythmia three groups contrast no significant postoperative 3d breath holding time B, C group was significantly longer than that in group A (P lt; 0.05); 4, awake and extubation time, first exhaust defecation time, postoperative hospital stay in group B and group C compared with group A is decreasing, but no statistics learning differences. Conclusion: lobectomy patients undergoing perioperative crystal glue (Ringer: Voluven, = 1:1) restrictive transfusion 5-10ml/kg.h: can basically maintain hemodynamic stability, Hct, Hb and blood gas no effect in 5ml/kg.h on surgery, postoperative recovery smaller impact. 2, can reduce the cytokine IL-6, IL-8 level, reduce the degree of lung injury, extended breath holding time after. 3, can reduce postoperative chest drainage, conducive to sobriety and recovery of patients after surgery, shorter hospital stays. Intermittent one-lung ventilation time the biological cause of lung injury within 48h after gradually restored to restrict the group ahead of trend. In view of the restrictive infusion of 5 ml / kg.h and there are differences 10ml/kg.h observations in a particular time period, smaller of 5 ml / kg.h. Patients, it is suggested that the clinical line the lobectomy surgery in patients with perioperative anesthetic liquid The restrictive transfusion management using 5ml/kg.h more reasonable.
|